Patients in a pilot study report wide-ranging benefits and reduced reliance on
drugs with adverse effects.

By Jeff Hergenrather, MD

A pilot study of the effect of cannabis on Crohn's disease
was conducted in California this summer by physicians in the Society of Cannabis
Clinicians. Crohn's is an inflammatory bowel disease which is disabling and
difficult to treat. The cause has not been established.

With co-authors Tod Mikuriya, MD, and David Bearman, MD, and
statistical support from Milton Harris, PhD, I developed a questionnaire to
assess the changes that Crohn's patients experience when they use cannabis on an
"ad lib" basis. We and SCC colleagues identified 32 Crohn's patients. Eighteen
expressed willingness to participate and 12 completed questionnaires.

Our results were reported at the International Association
for Cannabis as Medicine conference at Leiden University in the Netherlands in
September.

For all signs and symptoms evaluated in the study, the
patients described marked improvements with the use of cannabis. Beneficial
effects were reported for appetite, pain, nausea, vomiting, fatigue, activity,
and depression. Patients also reported that cannabis use resulted in weight
gain, fewer stools per day and fewer flare-ups of less severity.

Each patient rated all of these signs and symptoms on a 0-10
scale both on and off of the use of cannabis. The average or mean values were
then compared with paired T tests to show the average improvement patients
report for each category of study. A probability value was recorded for each
measurement to show how likely or unlikely these results could be expected to
occur randomly. All probability values, P values, reported were found to be
significant ( P= < .05 ) for the categories measured.

Crohn's disease remains a disease of unknown etiology. It
occurs in about seven out of 100,000 population, typically in people of European
decent. What can be said about it is that the immune system in the GI tract is
overreactive, misguided and destructive to the intestine. Components in cannabis
are thought to exert some of their beneficial effects by interacting with
cannabinoid receptors in the intestine.

Cannabis-using Crohn's patients not only report significant
relief of their symptoms, they are also able to reduce the amount of
immunosuppressive medications that have been a mainstay of conventional
treatment. Imuran, methotrexate, 6 MP, and Remicade (an anti-TNF drug) are
greatly reduced. Asacol and Pentasa brands of Mesalamine, an anti-inflammatory
medication with immuno-modulating properties is also reduced in many cases.
Steroids are noted to be reduced and often eliminated.

The immunosuppressives cause the same side effects that the disease
causes: nausea, vomiting, abdominal pain, and diarrhea. Mesalamine frequently
was reported to cause rash, itching, and photosensitivity. Steroids have a host
of common side effects including anxiety, depression, irritability, nausea,
vomiting, abdominal pain; and, with chronic use, bone thinning, glucose
intolerance, peptic ulcers, and the Cushingoid state.

Though our results are reliable and statistically significant, they could
be ignored as invalid because of the nature of the study. The patients were
self-selected, presenting to their doctor for approval to legalize their use of
cannabis. They all used their own cannabis of unknown quality and quantity.
There were no control groups of Crohn's patients who did not use cannabis; nor
were there any placebo-controlled trials with a group of patients using cannabis
stripped of its active ingredients.

Despite the fact that this pilot study deviates from the "gold standard"
study involving a treated group matched to a control group of untreated patients
double-blinded (where neither the researcher nor the patient knows if they are
getting the "real medicine" or not), the patients who responded nonetheless,
unequivocally report improvement in their symptoms and quality of life.

Some of the patients' responses include these telling remarks:
 "A terrific reliever of Crohn's symptoms."
 "A more easily controlled medication than offered by pills."
 "Alcohol has been a big problem for me that I don't have with cannabis."
 "Only positive effects, no negative effects."
 " Best appetite stimulant, very good calming effect."
 "Cannabis provides relief without knocking me out or other bad side effects
that I had with steroids."
 "I've committed myself to this form of therapy, and my quality of life has
improved by leaps and bounds."
 "I've struggled for years with opiate addiction from chronic pancreatitis
cannabis lets me control my pain without being a slave to opiates."
 "Marinol bothered my stomach I don't get sick, constipated, or vomit with
cannabis."

Our results are supported by a study published in the August 2005 issue of
the journal Gastroenterology. Researchers at the University of Bath determined
that cannabinoids activate the CB1 and CB2 receptors in the gut lining,
promoting it to heal the inflamed lining of the gastrointestinal tract.

Whereas the researchers in England are looking to synthesize cannabis-like
drugs that have these therapeutic benefits, California doctors are in a
situation where the natural medicine is available now. Many of us feel we don't
need chemists from the pharmaceutical industry to reinvent these molecules.
Cannabis works very well to relieve suffering. Patients using it show
significant improvement in their symptoms, weight, and the frequency of stools.

Crohn's disease is so debilitating and life-threatening and so difficult
to manage with conventional medications it is very encouraging to find that
cannabis is proving to be an effective treatment for it right now.

We hope to continue beyond the pilot study as more Crohn's patients become
aware of the beneficial effects of cannabis. Continuing to pretend that cannabis
has no health benefits, that it is addictive and dangerous to society as
portrayed by the Controlled Substances Act of 1970, should be and is an
embarrassment to civilized human beings. Cannabis should be removed from
scheduling and prescribed as any other medication.